慢性非插入性跟腱病患者的超声引导下电凝术：一项初步研究。
Ultrasound guided electrocoagulation in patients with chronic non-insertional Achilles tendinopathy: a pilot study.
作者信息
Boesen M Ilum, Torp-Pedersen S, Koenig M Juhl, Christensen R, Langberg H, Hölmich P, Nielsen M Bachmann, Bliddal H
机构信息
Parker Institute, Frederiksberg, Denmark.
出版信息
Br J Sports Med. 2006 Sep;40(9):761-6. doi: 10.1136/bjsm.2006.027334. Epub 2006 Jun 28.
BACKGROUND
High resolution colour Doppler ultrasound shows intratendinous Doppler activity in patients with chronic Achilles tendinopathy. Treatment of this neovascularisation with sclerosing therapy seems to relieve the pain. However, the procedure often has to be repeated.
OBJECTIVE
To investigate the effect of electrocoagulation of the neovessels on tendon pain and tendon vascularity in patients with chronic Achilles tendinopathy.
METHODS
Colour Doppler ultrasound guided electrocoagulation was used on vessels in the ventral portion of the Achilles tendon in 11 patients (seven men, four women, mean age 41 years) with painful chronic mid-portion Achilles tendinosis. A unipolar coagulation device was used.
RESULTS
One patient dropped out after two months (dissatisfied with the results). The remaining 10 patients (91%) were satisfied. These 10 patients were still satisfied at six months of follow up and had returned to their previous level of activity. All 10 patients were "cured" after one treatment. The patient who dropped out received two treatments because of lack of progress. There was significantly reduced pain (Likert pain scale, 0-10) during activity, from a median of 7 (range 4 to 10) at baseline to 0 (0 to 8) at six months' follow up (p<0.005); and at rest, from 1.5 (1 to 5) to 0 (0 to 8) (p = 0.005). In all patients, vascularisation was unchanged at the six months follow up, with no significant change in semiquantitative or quantitative colour scoring.
CONCLUSIONS
Coagulation in the area with vessels entering the tendon appears to be effective treatment for painful chronic mid-tendinous Achilles tendinopathy. No effect on the intratendinous Doppler activity could be detected, suggesting that the effect is independent of changes in blood flow. Localisation of hyperaemia appears to be the key to the pathology and for targeting the treatment. One explanation could be that the effect is obtained by destruction of nerves accompanying the vessels.
背景
高分辨率彩色多普勒超声显示慢性跟腱病患者腱内存在多普勒血流信号。采用硬化疗法治疗这种新生血管似乎可缓解疼痛。然而，该治疗过程通常需要重复进行。
目的
探讨对慢性跟腱病患者新生血管进行电凝治疗对肌腱疼痛和肌腱血管形成的影响。
方法
对11例（7例男性，4例女性，平均年龄41岁）患有疼痛性慢性跟腱中部肌腱病的患者，在跟腱腹侧部血管处采用彩色多普勒超声引导下的电凝治疗。使用单极电凝设备。
结果
1例患者在两个月后退出研究（对结果不满意）。其余10例患者（91%）表示满意。这10例患者在随访6个月时仍感满意，且已恢复至先前的活动水平。所有10例患者经一次治疗后均“治愈”。退出研究的患者因病情无进展接受了两次治疗。活动期间疼痛（Likert疼痛量表，0 - 10分）显著减轻，从基线时的中位数7（范围4至10）降至随访6个月时的0（0至8）（p<0.005）；静息时疼痛从1.5（1至5）降至0（0至8）（p = 0.005）。所有患者在随访6个月时血管形成情况未变，半定量或定量彩色评分均无显著变化。
结论
对进入肌腱的血管区域进行电凝似乎是治疗疼痛性慢性跟腱中部肌腱病的有效方法。未检测到对腱内多普勒血流信号的影响，提示该疗效与血流变化无关。充血部位的定位似乎是病理改变及治疗靶点的关键。一种解释可能是该疗效是通过破坏伴行血管的神经而获得的。
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